Post-Transplant Care

Going back home after kidney transplant will bring on some responsibilities as your further healthcare will be depend largely on you. But in case you develop any problem the transplant team will always be there to help you. Once the patient gets discharged from the hospital he will be given certain instructions by the doctor/transplant team. These include:

Monitoring health at home

When to call your transplant team

Schedule for the follow-up visits and further investigations

Medication schedule

How to avoid infection

Diet

Long term health checkups

It is imperative for the patient to follow these instructions religiously as the success of kidney transplant depends on all of these. Also talk over with your transplant team about the necessary precautions to be taken after transplant or about any other queries you may be having.

I. Monitoring health at home

The patient is asked to measure and record certain parameters such as weight, blood pressure, pulse, body temperature and urine output daily.

Measure your weight at the same time each morning, after you have gone to the bathroom. Use the same weighing machine. Record the weight daily in a transplant diary and in case you gain more than two pounds (approx. 1 kg) in a day or four pounds (approx. 2 kgs) in a week, meet your doctor immediately.

Measure your blood pressure and pulse at least once in a day or as advised by the doctor. It is important to know what your normal blood pressure is and consult the doctor if it goes above or below the normal range.

Measure your temperature first thing in the morning or whenever you feel chilled, hot, achy, or ill. Immediately consult your doctor if your temperature is higher than 100oF at any time. It may be the first sign of infection. Never take any medications to treat fever without consulting your doctor.

Monitor the daily intake and urine output . Closely monitor the total amount of fluid you take (intake) and the amount of urine you pass (urine output) over a period of 24 hours. This helps in assessing how your transplant organ is functioning. In case the urine output is decreasing, immediately contact your transplant team.

II. When to call your transplant team

Your transplant team will inform you regarding warning signs of infection and kidney rejection. These include:

Fever lasting for more than 2 days

Fluid retention or weight gain greater that two pounds (approx. 1 kg) in one day or four pounds (approx. 2 kgs) in a week.

Blood pressure or pulse are outside the range given to you by the transplant team

Urine output increases or decreases significantly

Pain or soreness in the area of your new kidney

The incision site becomes red, swollen and painful, or it oozes blood

Unusual weakness

Strong urine smell or blood in urine

Burning sensation while urinating

Frequent urge for urination

Shortness of breath

Dry cough continuing for more than a week or cough with yellow or green sputum

Prolonged nausea, vomiting or diarrhea

Inability to take prescribed medications

Rash or other skin changes

Exposure to mumps, measles, chickenpox or shingles

Vaginal discharge or itching

Immediately call the doctor/transplant team if you develop any of these symptoms or signs after transplant.

III. Be regular with your schedule for follow-up appointments and lab tests

Frequent visits to the hospital will be required tomonitor your progress and detect any potential complications at the earliest.

Follow-up appointments: You will meet your doctor at least weekly for the first month, every other week the second month, and every two weeks the third month. Thereafter, depending upon your progress your doctor visits will become less frequent. In case you are not able to keep up with some appointment contact your doctor for rescheduling the appointment.

Lab tests: The patient is given a schedule of tests to be performed after kidney transplant to detect any potential complications or side effects of immunosuppressive therapy. These commonly include:

Test for blood count. An increase in WBCs (white blood cells) may indicate infection or there may be a decrease in the cell count due to use of immunosuppressive medications.

Kidney function test: The levels of creatinine and BUN (Blood Urea Nitrogen) indicates how well the transplanted kidney is functioning.

Test for measuring electrolytes such as calcium, potassium, magnesium, sodium, phosphorous and bicarbonates. Any increase or decrease in these electrolytes can cause some adverse effects. Therefore, they need to be monitored at regular intervals as advised by the doctor.

Test for measuring blood glucose: Post-transplant diabetes is a common occurrence in kidney transplant patients. Hence the blood glucose levels need to be monitored from time to time.

Tests to monitor the medications level in blood: This measures the levels of medication in blood 12 hours after taking the evening dose. On the day you are going to have this test take your evening dose and go to the clinic next day. Do not take any medication until after the blood is drawn. It is essential to monitor the medication levels because too high levels can cause damage to the transplanted kidney or result in other serious complications whereas two low levels can cause kidney rejection.

Any other test may be advised by your doctor as needed.

IV. Take your medications regularly

After transplant you will have to take medications for the rest of your life. You will be put on immunosuppressive drugs (such as Cyclosporin, Mycophenolate Mofetil, Azathioprine and Prednisolone), which are required to prevent your body from rejecting the new kidney. The patient should take care of the following:

Take your medications at the same time, in the same dose every day as advised by your doctor.Missing even a single dose may make it more likely for you to have a rejection.

Swallow the capsule as a whole; do not crush, chew or open it.

Never stop or reduce the dose of any medication without consulting your doctor. Doing this can cause a rejection episode.

If you skip a dose take it as soon as you remember and call your doctor. However, if it is time for the next dose, do not take a double dose.

If you are not able to take your medications due to any problem (such as vomiting) contact your doctor for an alternative.

Check with your doctor before taking any over-the-counter or prescriptiondrugs.

Do not stop taking medications on development of any side effects. Immediately consult your doctor.

The immunosuppressants make your skin sensitive to sunlight, therefore apply sunscreen whenever going out in sun.

Always keep a one to two week supply of medication on hand at all times to prevent running out of these medications.

Keepall the medicationsat room temperature, away from direct sunlight and with the cap tightly closed.

Do not refrigerate the medications unless mentioned on the label.

Do not keep medications in your car cabinet

If you are traveling to a time zone where the time is no more than three hours different than the time at home, consult your doctor for change in your medication times.

The immunosuppressive drugs lower the immunity of the body, reducing the person’s ability to fight off infection. Due to this kidney transplant patients are at increased risk of acquiring infections. Therefore, it is essential for them to maintain a good personal hygiene and avoid getting infection from other sources.

A) Maintain personal hygiene

Take a shower or bath regularly.

Change your undergarments regularly.

Change your hand towels or face towels daily.

Brush your teeth regularly at least two times. Brush gently to prevent any injury to the gums.

Wash your eyes regularly with clean water.

Keep your nails clean and trimmed.

Always wash your hands before taking meals or after going to the toilet. Use a soap dispenser rather than a soap bar.

Wash hands after coughing or sneezing, and throw tissues into the trash immediately.

Scrub hands with soap for at least 10 seconds and take care to rub between your fingers.

During menstruation females should change sanitary pads and tampons regularly.

Do not wear the same socks regularly as it can cause foot infection.

Wear shoes when walking outside, to prevent exposure to soil microorganisms through cuts in your feet.

B) Avoid getting infection from other sources

Do not share razors, toothbrushes, or eating and drinking utensils.

Avoid people having cold, cough or any other infection.

If someone in your family is suffering from cold or cough ask them to follow the normal precautions (such as using separate drinking glasses, towels, covering their mouths when coughing, etc.)

Always take some antibiotics prior to any dental work or any other invasive procedures. If, required continue them as per your doctors advise.

Wash hands after touching objects which are at risk of carrying microorganisms such as doorknobs, public telephone etc.

Do not take vaccines that contain live viruses such as oral polio, measles, mumps, German measles as the live virus can cause infection.

Avoid contact with family members who were recently immunized especially children receiving the polio vaccine as the virus is shed in their stool.

Avoid keeping pets at home

Eat and drink safe

VI. Diet

Proper nutrition plays a major role in recovering from kidney transplantation. After transplantation (as in any other surgery) you need to take adequate proteins and calories, as they are essential for proper healing. The side effects of immunosuppressive or anti-rejection medications increase the nutrient requirements. Steroids intake increases the appetite and causes sodium and water retention. Due to these specific concerns, you may have to modify your diet regime for a time period after your transplant. Here are some guidelines regarding diet after renal transplantation:

Take a high protein diet, as it will help to build and repair muscle and tissues. Some good sources of proteinare meats (beef, pork, poultry, seafood), fish, dairy products, eggs (up to 3 per week), nuts, beans, pulses, soyabean and soyabean products.

Some corticosteroids can decrease the body’s ability to use glucose/sugar for energy. This can cause increased blood sugar (glucose) levels. This condition is called hyperglycemia or steroid-induced diabetes. Hence, it is advisable to take complex carbohydrates (such as wheat, rice, other cereals, bread, potatoes etc.) instead of simple carbohydrates (such as sugars, honey, jam, jellies, marmalades, candies, soft drinks, sweetened fruit juices, ice creams, sherbets etc.)

Transplant patients are at increased risk of developing heart diseases and the long-term usage of Cyclosporin and steroids induces weight gain and high blood cholesterol levels. Hence take fats/oils sparingly in your diet.

Take a moderate sodium restricted (no added salt) diet, as it will reduce the chances of fluid retention and assist in controlling blood pressure.

Some drugs (like cyclosporine) can increase the potassium level in your blood. Hence, proper assessment of potassium levels is required prior to any change in medication and/or diet.

Take adequate amounts of calcium and vitamin D. However, regular assessment of these two nutrients is essential to reduce the chances of any complications.

Avoid alcohol: The immunosuppressive drugs (that prevent kidney rejection) such as cyclosporine, Azathioprine are metabolized in the liver. Alcohol too is metabolized in liver. Hence, if you take alcohol it can reduce the efficacy of these medications resulting in the rejection of the transplanted kidney.

To know more about Nutritional care after renal transplant, click here

VII. Health check-ups

As you already no by now that use of immunosuppressive drugs decreases your immunity thereby increasing your risk of having infection, cancer or other diseases. Hence, you will need to undergo various screening test from time to time.